Reducing pain during vaccine injections: clinical practice guideline

Importantly, many pain mitigation interventions can be offered for little or no cost. Even for those with costs, the costs may be offset by avoiding the costs of subsequent harm from unmitigated pain and fear, including the negative impact on health outcomes due to vaccine hesitancy and noncompliance with other health care interventions, and the costs for treatment of needle fears that have developed due to poorly managed pain. Performance metrics can include clinical indicators (e.g., pain intensity, fear intensity), process indicators (e.g., use of pain interventions, compliance with vaccination) and conceptual indicators (e.g., knowledge, satisfaction). Appendix 5 (available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.150391/-/DC1) and a global vaccine safety research network (https://brighton collaboration.org)26 offer some sample tools for assessing pain and related outcomes, and documenting pain interventions used. Data are needed on the painfulness of different vaccines (including their route of administration), aspects of vaccine injection technique (e.g., speed of injection and injection in a single limb for multiple vaccine injections), and vaccine formulations and delivery systems that minimize pain. Given the potential role of memory for pain and fear in subsequent experiences of pain,27 research is needed to examine the efficacy of interventions for memory reframing. Studies on the impact of pain interventions on future pain and vaccine compliance are also warranted to show the long-term impact of pain interventions. Affiliations: Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology ([C. Meghan McMurtry PhD]), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology ([Rebecca Pillai Riddell PhD]), York University, Toronto, Ont.; Departments of Pediatrics ([Christine T. Chambers PhD]), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development ([Melanie Noel PhD]), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadi